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Date of Birth
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Membership Type (required)
First Claim - £31Second Claim - £20Social - £10

First Name Club (if other than Kippax)

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Bank Transfer (please see bank details below and make sure, your name is referenced)PayPalCash or Cheque at Club

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Declaration

I certify that the above information is true and correct to the best of my knowledge.
I understand that membership is voluntary and at my own risk.
I agree to abide by the rules and constitution of the club.
I agree to the information I have provided being stored on the club database, shared with other club members and for membership purposes.

By ticking this box, I confirm I have read and agree to the above declaration